Lessons on integration from the developing world's experience

British Medical Journal, Jan 20, 2001 by Gerard Bodeker

Conversely, health insurance can increase access to traditional medicine. In Taiwan, four out of five people would use traditional Chinese medicine if it were covered by national health insurance.[4] In Australia the use of acupuncture by doctors has increased greatly since the 1984 introduction of a Medicare rebate for acupuncture. In 1996, 15.1% of Australian doctors claimed for acupuncture, with almost one million insurance claims made.[13]

Insurance schemes for traditional and complementary medicine are biased towards those with the ability to pay. An equity formula is needed if the poor are to be guaranteed access to these services.

Drawing from the Asian experience,[4] it is clear that effective integration strategies will promote communication and mutual understanding among different medical systems, evaluate traditional medicine in its totality, integrate at both theoretical and clinical levels, ensure equitable distribution of resources between complementary and conventional medicine, provide a training and educational programme for both traditional and conventional medicine, and generate a national drug policy that includes herbal medicines.

Summary points

Integration works best when based on self regulation in relation to standards of practice and training

This needs to be matched by a central or regional system for drug control and evaluation and maintenance of good manufacturing practice; this system should also generate and support a comprehensive programme of research

When conventional medicine dominates complementary medicine, loss of essential features of complementary medicine can occur, and professional conflicts can arise

Policy should aim to keep tees for complementary medicine affordable and within reach of all levels of society

Major sectoral investment is a prerequisite for the development of effective services for complementary medicine; underinvestment risks perpetuating poor standards of practice, services, and products

Considerations by the Commonwealth Working Group on Traditional and Complementary Health Sytems

* Policy framework, including integration of traditional and conventional medicine, regulation, and provision of services

* Training of traditional and conventional practitioners

* Development of standards of practice

* Mechanisms for enhanced sharing of experiences by countries

* Evidence based research and safety of herbal medicines and practices of complementary medicine

* Conservation of medicinal plants and related intellectual property rights

Competing interests: None declared.

[1] Astin JA. Why patients use alternative medicine: results of a national study. JAMA 1998;279:1548-53.

[2] Bannerman RH. Traditional medicine and healthcare coverage. Geneva: World Health Organization, 1983.

[3] Bodeker G. Traditional (i.e. indigenous) and complementary medicine in the Commonwealth: new partnerships planned with the formal health sector. J Alternative Complement Med 1999:5:97-101.

[4] Chi C. Integrating traditional medicine into modern health care systems: examining the role of Chinese medicine in Taiwan. Soc Sci Med 1994;39:307-21.